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Annals of Oncology 10:S278-S280, 1999
© 1999 European Society for Medical Oncology

Endoscopic palliative treatment of advanced pancreatic cancer: Thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy

G. Giraudo, G. Kazemier, C.H.J. Van Eijck and H.J. Bonjer

Department of Surgery, University Hospital Dijkzigt Rotterdam, The Netherlands

Correspondence to: Jaap Bonjer, MD, PhD, Department of Surgery University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands, E-mail: bonjer{at}hlkd.azr.nl

Design: Evaluation of thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy as endoscopic palliative treatment of advanced pancreatic cancer.

Patients and methods: Between November 1993 and September 1998 we performed 16 thoracoscopic splanchnicectomies and 6 laparoscopic gastrojejunostomies in patients with an advanced pancreatic cancer admitted to the Department of Surgery of University Hospital Rotterdam - Dijkzigt. These patients either did not achieve adequate pain control with medication or presented serious problems of gastric outlet obstruction, or both.

Results: There were fourteen patients (9 men and 5 women) with mean age of 51.8 years (range 28–83), mean BMI of 21.1 (range 17.2-27.2), ASA score I in 2, II in 11, HI in 1. We performed 2 left, 2 right and 4 bilateral thoracoscopic splanchnicectomies, 4 laparoscopic gastrojejunostomies and 2 combined endoscopic procedures (bilateral thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy). The overall average operation ( "skin to skin") time was 86 minutes (range 75–100) for bilateral thoracoscopic splanchnicectomies, 63 minutes (range 60–65) for unilateral splanchnicectomies, 88 minutes (range 65–115) for laparoscopic gastrojejunostomies and 190 minutes (range 180–200) for the combined procedure. Blood loss was insignificant with a median of 50 ml (range 30–150). The conversion's rate to open surgery was 4.5%. There were no intraoperative complications. The overall average postoperative mobilization was in 1.9 days (range 1–4) and the overall median postoperative hospital stay was 7 days (range 2–24). There was no mortality at 30 days after endoscopic procedures and the morbidity rate was 21.4%. The postoperative analgesic requirement was considerably reduced with a successful rate was 83.3%. The resolution of gastric outlet obstruction has been complete in all laparoscopic gastrojejunostomies.

Conclusions: Our results show the feasibility and safety of these minimally invasive approaches such as endoscopic palliative treatment of complications of advanced pancreatic cancer.

complications, gastrojejunostomy, minimally invasive surgery, laparoscopy, pain, pancreatic cancer, splanchnicectomy, thoracoscopy


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